• Call: (844) 569-8628
  • |
  • Get a Quote
  • |
  • COVID-19 Updates
  • |
  • Log In
DrChrono gray logo
  • Solutions
    • Providers
    • EHR by Specialty
    • Telemedicine
    • Large Practice
    • Small Practice
    • Multi Specialty

    • Patients
    • Patient Portal - OnPatient

    • Partners & Affiliates
    • Become a Partner
    • API Developers
    • Affiliate Information
    • Apple Mobility Program
  • Platform
    • Product
    • Electronic Health Records
    • Telehealth
    • Practice Management
    • Medical Billing
    • Revenue Cycle Management
    • Patient Portal
    • Mobile EHR Solutions
    • App Marketplace

    • Features
    • All Features
    • Lab & Imaging
    • eRx & EPCS
    • Medical Templates
    • Feature videos
  • Resources
    • Resources & Tools
    • Resources
    • Case Studies
    • Blog
    • Specialties
    • Testimonials
    • Webinars
    • Plans
    • ONC Certification

    • Customer Help
    • Support Center
    • Training videos
  • Company
    • About Us
    • Blog
    • Diversity
    • Life & Culture
    • Press
  • Telehealth
  • Try Now
DrChrono gray logo mobile menu icon
Close out of menu icon
  • Solutions
    • Providers
    • EHR by Specialty
    • Telemedicine
    • Large Practice
    • Small Practice
    • Multi Specialty

    • Patients
    • Patient Portal - OnPatient

    • Partners & Affiliates
    • Become a Partner
    • API Developers
    • Affiliate Information
    • Apple Mobility Program
  • Platform
    • Product
    • Electronic Health Records
    • Telehealth
    • Practice Management
    • Medical Billing
    • Revenue Cycle Management
    • Patient Portal
    • Mobile EHR Solutions
    • App Marketplace

    • Features
    • All Features
    • Lab & Imaging
    • eRx & EPCS
    • Medical Templates
    • Feature videos
  • Resources
    • Resources & Tools
    • Resources
    • Case Studies
    • Blog
    • Specialties
    • Testimonials
    • Webinars
    • Plans
    • ONC Certification

    • Customer Help
    • Support Center
    • Training videos
  • Company
    • About Us
    • Blog
    • Diversity
    • Life & Culture
    • Press
  • Try Now Log In
Initial Evaluation
In-Home Visit & Consent?
In-home Covid-19 Screening Questions last 48 hours
• • •
Virtual session & Consent
Patient Location Address & County at time of Virtual Session
Where was the patient during the virtual session?
Subjective
Patient's present complaint
Date symptoms first started
History of present complaint
Has the patient had prior treatments?
Describe previous treatments
Symptoms
• • •
Investigations and Imaging
Pain
MSK-HQ initial eval score
Current Verbal Numeric Pain Rating Scale
Pain at Best (0-10) & Type
Paint at Worst (0-10) & Type
Aggravating Factors & Time
Easing Factors & Time
24 hour pain pattern
Morning pain
During the day
At night
Red Flag Signs
The patient reports no red flags
S4 Signs
Details on S4 Sign
Lumbar
Details on Lumbar Signs
Cervical artery
Details on Cervical Artery Signs
Cervical Instability
Details on Cervical Instability
Knee
Details on Knee
Past Medical History
Past Conditions
• • •
Please provide detail on past conditions
Medications and allergies
Social History and Psychosocial Factors
Occupation, Activities/Hobbies
Has worrying thoughts about pain / condition
Please explain
Feels that their pain is terrible and it is never going to get better
Please explain
Feels that they are avoiding activities because of their pain
Please explain
Patient goals and expectations
Patient specific goals (SMART)
Patient expectations of treatment
Objective
Observations / posture / gait
Range of motion
Neurological & Neurodynamic testing
Muscle testing
Functional Tests
Observed Moment Dysfunction
Special tests
Palpation - positive findings
Assessment
Assessment
Diagnosis
Plan
Plan - Include Freq/Duration (e.g. 1-2/wk for 8 weeks)
3 Short-term Goals (SMART)
3 Long-term goals (SMART)
Treatment Procedures
Evaluation complexity
Interventions & TIme
Is this a DIRECT ACCESS patient? (for physician signature)
Is this a Medicare Patient?
Certification effective from (mm/dd/yyyy Eval)
Certification end mm/dd/yyyy (Eval + 90day)
To Be Completed By Physician (Medicare Certification)
Billing can be found in the H&P and SOAP sections
PROGRESS NOTE
Diagnosis (do not include ICD codes)
# of Completed Appointments
# of Cancellations
# of No Shows
SUBJECTIVE
Subjective Findings
• • •
Other Subjective Findings
Current Verbal Numeric Pain Rating Scale
% Overall Improvement
Pain at Best (0-10) & Type
Paint at Worst (0-10) & Type
MSK-HQ
OBJECTIVE FINDINGS
Todays Objective Findings
Todays Treatment
ASSESSMENT
Assessment Description
• • •
Other Assessment Description
Potential to reach goals
Overall Assessment
Problem List
Notes
PLAN
GOALS
Short Term Goal #1
Goal Status
Short Term Goal #2
Goal Status
Short Term Goal #3
Goal Status
Long Term Goal #1
Goal Status
Long Term Goal #2
Goal Status
Long Term Goal #3
Goal Status
Additional goals from Initial Eval
Recommended Treatment Plan + Frequency & Weeks
Plan of Care (POC)
Expected # of Remaining Visits
To be completed by Physician
To Be Completed By Physician

PT Initial Evaluation & Progress Note Medical Form

Physical Therapist

There are 0 copies in use.
Published: Dec. 12, 2022, 7:18 p.m.
Doctor: Dr. History Physical
Rating: 0   /

Use this form Back to list

Download PT Initial Evaluation & Progress Note

If you have an account, log in to use or rate this form. Log In

Click to use an int'l or other #

Don't have an account? Sign up to use this form. Sign Up

Close
DrChrono white logo

328 Gibraltar Dr
Sunnyvale, CA 94089

Call us: (844) 569-8628

Apple app store logo
  • Free EHR Demo
  • EHR
  • Practice Management
  • Medical Billing
  • Revenue Cycle
    Management
  • Patient Portal
  • Mobile EHR
  • eRx
  • Plans
  • EHR Features
  • Lab & Imaging
  • Patient Education Materials
  • Universities & Schools
  • Security Policy
  • SSO Log In
  • EHR Checklist
  • Meaningful Use
  • EPCS
  • MACRA & MIPS
  • ICD-10 Info
  • Share your Experience
  • OnPatient Portal
  • OnPatient Terms of Use
  • OnPatient Privacy Policy
  • Security Policy
  • Support Center
  • Developer API & SDK
  • EHR FAQ
  • Medical Billing Calculator
  • Medical Form Library
  • Insurance Lookup
  • ICD & HCPCS Lookup
  • App Directory
  • About Us
  • News & Updates
  • Careers
  • Contact Us
  • Testimonials
  • Logos & Branding
  • Our Flickr
  • Press
© Copyright 2019 DrChrono Inc.
  • Privacy Policy
  • Terms of Use
  • Site Map
  • twitter icon
  • facebook icon
  • youtube icon